CEO Report to the Board Q3 2016/17

CEO Report to the Board Q3 2016/17

TABLE OF CONTENTS: 1. Introduction 2. MOHLTC Updates 3. i. Designing Healthcare for the Future ii. Taking a Population Health Approach iii. Transforming Primary Health and Community Care iv. Achieving Excellence in Operations 4. Accountability 5. 6. 2

1. Introduction Over the fall, the Toronto Central Local Health Network (LHIN) has been actively moving forward to advance our key strategic priorities and reach our goal of a healthier Toronto. Our strategic plan set us on a course aligned to the government s Patients First Act 2016 (Bill 41) which was passed on December 7th, 2016. With the passing of this legislation, all Toronto Central CCAC assets will be transferred to the Toronto Central LHIN by 2017-18, though a transition process with guidance from the Toronto Central Transition Team, tasked with guiding the planning and implementation of Transition for Toronto Central CCAC and Toronto Central LHIN. Throughout this process, our priorities will be to ensure that the high-quality client care that CCAC delivers every day continues uninterrupted and there are no unnecessary disturbances to our partners. The Toronto Central Transition Team has agreed on the following principles that guide our work together: Transition discussions begin from a position of trust There is transparency in our relationship The new organization will build on the successes and strengths of both the LHIN and CCAC Our priority is the continued delivery of high quality care throughout transition We re committed to robust communications with staff, providers and partners We will engage employees to create an inspiring future vision for the new organization Our change management plan will reflect the needs and cultures of both organizations Staff will see their role in the future organization Service Providers will continue to be valued partners The Toronto Central LHIN and CCAC are both widely regarded as leaders and innovators, and as we all embark on this important and exciting journey together, we are united by our shared commitment to making a difference for patients and their families. As a new and much stronger organization, we will be able to deliver even more integrated and responsive care to those we serve. 3

2. MOHLTC Updates Ontario Establishing Patient and Family Advisory Council Ontario is creating a Patient and Family Advisory Council to advise government on health policy priorities that have an impact on patient care and patient experiences in Ontario. The council will involve patients, families, and caregivers in the policy development process, ensuring that their needs and concerns are fully understood, and will help the health system become more responsive, transparent and accountable. Members of the council will be chosen through a public process that includes opportunities to nominate suitable candidates. To learn more about the patient and family advisory council, please click here. Making More Vaccines Available in Pharmacies Starting December 15, pharmacists will be able to administer more vaccines in Ontario. To learn more about the vaccines now available in pharmacies, please click here. Ontario Passes Legislation that Delivers Better Health Care for Families On December 7th, Ontario passed legislation that will help patients and their families obtain better access to a more local and integrated health care system, improving the patient experience and delivering higher-quality care. The Patients First Act will help ensure patients are at the centre of the health care system. To learn more about the legislation, please click here. 4

The Protecting Patients Act, 2016 The Protecting Patients Act would, if passed, amend four statutes and enact one new statute to support Ontario's Patients First: Action Plan for Health Care. Ontario is proposing legislative amendments to strengthen, uphold and further reinforce a zero tolerance policy on patient sexual abuse by any regulated health professional. Acts of professional misconduct involving the sexual abuse of a patient are always unacceptable. The relationship between a patient and their regulated health professional must be built upon a foundation of trust, confidence, and safety. To learn more about the Protecting Patients Act, please click here. Ontario Introduces Legislation on Medical Assistance in Dying- Dec 7th, 2016 Ontario has introduced legislation that would, if passed, support the implementation of medical assistance in dying by providing more protection and greater clarity for patients, their families and their health care providers. Federal legislation, which passed in June 2016, guides how medical assistance in dying can be provided. The province's proposed Medical Assistance in Dying Statute Law Amendment Act aligns with the federal medical assistance in dying legislation and would address areas that fall under provincial legislation. To learn more about the legislation on medical assistance in dying, please click here. 5

Capital Projects: The Health Capital Investment Branch (HCIB) at the Ministry of Health and Long-Term Care (MOHLTC) and the Toronto Central LHIN work closely together addressing Capital Redevelopment and Infrastructure needs within our health service providers facilities. The LHIN s role is to ensure that program and service needs for our patients are met, and to determine if there will be any impacts on operational funding. The LHIN is involved within the first three stages of the Capital Planning process, which moves from the early conceptual stage, to the development of a functional plan. Current projects underway within the Toronto Central LHIN are summarized below. These projects will help to ensure that patient care can be provided according to current standards, safely and efficiently. Some will help increase capacity and allow for new programs to take place (such as West Park s Geriatric Day Hospital). Others will help decrease wait times and ensure that patients will not have to travel out of country for their care (such as Sunnybrook s Malignant Haematology Centre and UHN s Stem Cell Transplant programs). 6

Pre-Capital Stage 1 Stage 2 Sunnybrook Malignant Haematology Centre (Headstart & Phase 2) St. Joseph s Major Capital Redevelopment UHN Stem Cell Transplant (Phase 2) CAMH Phase 1D Capital Development (Forensics) Renascent (Renovations) Transition House (Renovations and expansion) Pine River Institute (Girls Dormatory development) Sound Times Capital development (adjacent vacant space) 4 Villages (Development of Mavety Site) St. Michael s Satellite Dialysis (Overlea Blvd) St. Michael s Men s Withdrawal Management Program SickKids Project Horizon LAMP Redevelopment West Park Major Capital Redevelopment Anishnawbe Health Toronto Major Capital Development 7

3. : Designing health care for the future I. Citizens Panel: The Toronto Central LHIN Citizens Panel met twice in Q3 in October and November. Tai Huynh from OpenLab, was invited to the October 18th s meeting to present examples of resources him and his colleagues have developed and welcomed feedback from panel members. Two of these items included a Patient- Oriented Discharge Summary, a tool created to help patients understand the steps they need to take when discharged from a hospital, as well as an interactive hospital handbook designed to assist patients and family members with navigating hospitals during their visit. During the November 22nd Citizens Panel meeting, Zal Press and Jodeme Goldhar from Toronto Central CCAC, presented on One Community, and how members of the Toronto Central LHIN Citizens Panel, as well as other community members and service providers can participate in the co-creation of a shared vision to inform how the LHIN and CCAC will integrate home care, health care, community care, mental health and other services. Panel members were also extended the opportunity to participate in the Roadmap Summit, a full day co-creation exercise on December 13, 2016 to vision and plan a roadmap for a better, more integrated system with better outcomes. Participants included citizens, service providers and front-line workers. The strategy that emerged from the Roadmap Summit will be developed by the end of March 2017 by a reference group working to co-create the Roadmap strategy. 8

II. Development of a Regional Framework: The focus for Q3 was to define, scope and complete an initial inventory of regional services in Toronto Central LHIN; to inform the development of a regional framework. In Q3 a working group was established to support this initiative, with Anne-Marie Malek & Mohamed Badsha as co-chairs. The initial working group meeting (October 12, 2016) was followed by an engagement session (October 31, 2016) with Toronto Central LHIN Health Service Providers (HSPs) who had self-identified as regional services providers through the sub-region planning and engagement process. Feedback from providers and liaison with other stakeholders (including MOHLTC & Toronto Central LHIN Primary Care Access to Specialists) supported further development of the definitions and informed the scope of this framework to focus on specialized regional services. 9

Taking a population health approach III. Toronto Central Palliative Care Network In the Fall 2016, Toronto Central LHIN and Toronto Regional Caner Program jointly developed the Toronto Central Palliative Care Network ( the Network ), with the goal of bringing together health service providers and stakeholders to collectively work towards developing a comprehensive, integrated and coordinated system of palliative care. The Network will support provincial priorities as directed by the Ontario Palliative Care Network (OPCN) and it will also regional priorities, aligning with both LHIN and the Regional Cancer Program s s. The mandate of the Network is to be: - Regional Advisors on high quality palliative care, informing the LHIN and Regional Vice President of decision making - Accountable for local quality improvement, data and performance measurement - Drive quality improvement across all sectors based on best practices in accordance with the OPCN direction and the Declaration of Partnership. 10

In 2016/17, the Toronto Central Palliative Care Network is focused on establishing the governance of the Network, as well as undertaking several foundational activities that will help inform the work of the Network in 2017/18. Highlights of these foundational initiatives include: - Recruiting of Dr. Kirsten Wentlandt and Ms. Susan Blacker as the two Regional Palliative Care Clinical Co-Leads to support the work of the Palliative Network - Regional Palliative Care Stakeholder Consultation, held on November 18, 2016 - Palliative Care Needs Assessment of the Homeless & Vulnerably Housed in Toronto Central (underway) - Assessment of Primary Care Providers Palliative Care Education &Training Needs (underway) - Preliminary review of hospital palliative care unit bed access and utilization, using an equity and population health lens (underway) The Network is currently refreshing the Palliative Care Strategy, and developing their work plan for 2017/18. IV. RESIDENTIAL HOSPICE In October 2016, the Ministry of Health and Long-Term Care confirmed their support of moving forward with a 23 (new) hospice bed expansion by 2018/19 in the Toronto Central LHIN. The Toronto Central LHIN issued an Expression of Interest process in the summer of 2016, in anticipation of this new funding opportunity, and was quickly able to identify how to allocate the new residential hospice beds: - 10 beds: new residential hospice targeting the homeless/vulnerably housed. Led by Hospice Toronto, in partnership with Inner City Health Associates, St. Elizabeth Healthcare & other community partners - 9 beds: residential hospice expansion at Kensington Hospice. - 4 beds: residential hospice expansion at Emily s House (pediatric hospice) 11

V. Local Collaboratives: Between October 11th and 25th, 2016, representatives of health service providers from across the Toronto Central LHIN along with members of the Citzens Panel and local partners, met to begin the process of local collaborative planning. Several neighborhood profiles were completed for each of the sub-regions to give the attendees a deeper understanding of the local neighborhoods and populations within each sub-region including their health care utilization, health status and outcomes, and disparities related to certain socio-demographic characteristics. On a high level the criteria to select neighborhoods included: a) High or low needs neighborhoods with interesting patterns; b) Presence of vulnerable population groups (e.g. low income, recent immigrants etc.); c) Unique characteristics identified in neighborhoods (shared between sub-regions, high growth areas etc.); d) Engaged for certain local initiatives (e.g. primary care managed entry, neighborhood improvement areas). Planning for the Local Collaborative sessions in Q4 is underway with visitations to prospective meeting venues and discussion of preliminary agenda items. Smaller sub-region working groups consisting of the region s Primary Care Clinical Lead, Community Care Lead, and Hospital Resource Partner were also organized to help guide and focus the work for the upcoming winter sessions. 12

VI. Toronto Indigenous Health Advisory Circle (TIHAC) The TIHAC subcommittee is working on a local strategy for Missing and Murdered Indigenous Women and Girls for the National Inquiry starting up in the spring of 2017. The LHINs in partnership with an Indigenous Trans and Two Spirited committee and Anishnawbe Health Toronto is working on an Indigenous community engagement strategy and needs assessment. Current state data will be provided by Well Living House, Centre for Urban Health Solutions. The TIHAC has started work on a MHA strategy working with UHN and a TIAHC Elder. Toronto Central LHIN has invested in a cultural safety training strategy working with the Ontario Federation of Indigenous Friendship Centres for in person training LHIN staff, board and HSP s. Toronto Central LHIN is also allocating online Indigenous Cultural Safety seats from an initial allocation from the MOHLTC which are offered to all LHIN staff, board and HSP s. The TIHAC youth council is working on an Indigenous youth health forum in partnership with Toronto Public Health. Members of TIHAC are sitting on both the health equity table and the population health and equity strategy leadership table. VII. Health Equity Data Collection In the fall, the Sinai Health Team that leads the Toronto Central LHIN Health Equity Data Collection project held train-the-trainer workshops for all the community health centres and hospitals staff that led the collection of equity data. They provided information on the purpose of the eight Toronto Central LHIN socio-demographic questions, and facilitated sharing of best practices and successes around equity data collection and use, and addressing challenges in collecting the data. 13

Tranforming Primary Health Care VIII. Primary Care Toronto Central LHIN continues to advance the implementation of our primary care strategy s goals and objectives. Primary and Community Care Committees have been established in all 5 sub-regions and have been meeting since November to review local population and health system data and are currently developing work plans for the 2017/18 fiscal year. Work groups have been established for the five strategic priorities (Attachment, Access and Continuity; Access to Interprofessional Teams; Discharge Planning; Access to Specialists; and Secure ) to provide recommendations and oversee implementation of funded initiatives. Work continues on the Primary Care Provider Census that aims to collect primary care physician data to assist with future planning. The pilot phase was completed in Q3 and the project moved on to collecting information from Community Health Centres and Family Health Teams. The best available data did not have reliable clinic addresses and locations of physicians offices, which has been clarified by the team for approximately 96% of physicians in Toronto Central LHIN. 14

IX. Integrated Community Care The Toronto Central LHIN has launched an integrated community care initiative as part of our 2015-18 and in partnership with the work underway to strengthen primary care. Over the next several months, the Toronto Central LHIN, Toronto Central CCAC and our community partners will come together to define the building blocks of a client-centred, highly coordinated system of care that is easy to navigate and easy to access for clients and caregivers. A move toward integrated community care requires collaboration across many providers, and must be guided by a shared vision for health service delivery that responds to local need. A full-day Roadmap Summit was held on December 13th that brought together more than 170 sector staff and leaders, clients and caregivers, primary care and other partners. It proved to be a hands-on, highly active day of collaboration which generated solutions for a more integrated system of care that enables improved access, coordination and navigation for clients and caregivers. 15

Achieving Excellence in Operations X. Joint Transition Toronto Central LHIN and Toronto Central CCAC Planning On December 7 th, Bill 41 Patients First Act was passed and indicated that CCAC assets would now be transferred to LHINs through a transition process over 2017-18. In preparation for the passage of Bill 41, a transition team was created and is led by Bill Manson from Toronto Central LHIN and Ann Wojtak from Toronto Central CCAC. A communications plan leading both organization toward the passage of the legislation, with communications internally to LHIN, LHINC, LSSO and CCAC staff, externally to health service providers and service provider agencies, as well as an update to both corporate website. To support the Transition principle of transparency a shared internal communication newsletter, The Advance was developed with the first issue to be released in January of 2017. 16

4. Accountability MLAA Summary Dashboard (1 of 2) Toronto Central LHIN is meeting 3 of the 14 MLAA indicators (CCAC Nursing Visits, Knee replacement Wait Time and ALC Rate) and is within 10% of meeting targets for anothe r 2 indicators (CCAC Personal Support Worker visits and Hip replacement Wait Time). 17

MLAA Summary Dashboard (2 of 2) 18

Notes: Toronto Central LHIN has undertaken some analysis on five (5) main indicators, namely A lternative Levels of Care (ALC) Rate, Percentage of ALC Days, Repeat Emergency Department (ED) visits for patients with mental health needs and substance abuse needs and Readmissions within 30 days for selected clinical conditions: For Percentage of ALC Days and ALC Rate: 1% of discharged long -stay patients ( 190 days) contribute to 27.6% of ALC days. Discharges of long stay patients from hospitals have a disproportionate negative impact on this indicator. If we exclude this 1% cohort, Toronto Central LHIN is meeting the targets for Percentage of ALC Days and ALC Rate : 2016/17 Q1 Adjusted Percentage of ALC Days is at 8.9% for compared to the actual result of 12.16% 2016/17 Q2 Adjusted ALC Rate is at 8.7% compared to the actual result of 12.7% For Repeat ED visits for patients with mental health needs and substance abuse needs: We are considering u nique patients who had a repeat ED visits for these two conditions within 30 days. On average, Toronto Central LHIN patients have the highest repeat ED visit rate of 1.88 compared to the province (1.64) for mental health and the second highest repeat ED visit rate for substance abuse at 2.44 compared to the province (2.36) 2016/17 Q1 Adjusted Repeat ED visits for unique patients with mental health needs is at 20.18% for compared to the actual result of 28.04% 2016/17 Q1 Adjusted Repeat ED visits for uni que patients with substance abuse needs is at 27.3% compared to the actual result of 42.3% For Readmissions within 30 days for selected clinical conditions: Investigation has shown that the Provincial Reference Rate is higher than the average of Specialty Children s Hospitals readmissions rate and the Risk Adjusted rate for all Specialty Children s Hospitals is higher than the Crude Rate for Readmissions within 30 days. 19

2015/16 Q4 Adjusted Readmissions within 30 days for selected clinical conditions is at 16.96% for compared to the actual result of 17.69% 20

& Community 5. The third quarter saw much activity in the area of integrations. Four voluntary integrations were presented to the Board. Each integration was approved to proceed to their integration date. The integrations are: Parkdale Community Health Centre & Queen West Central Toronto Community Health Centre The Hospital for Sick Children & Hincks Dellcrest Children s Centre Anne Johnston Health Station & Tobias House Inc. Access Alliance Multicultural Health Centre & The Neighbourhood Centre 21

& Community The Board also approved the plan to implement the recommendations from the third party review, Advancing the Conversation. The implementation plan responds to the three initial questions that originally launched the third party review: How does Toronto Central LHIN sustain success in voluntary integrations? How does Toronto Central LHIN successfully lead facilitated integrations? Where should Toronto Central LHIN look to lead facilitated integrations? Implementation of the seven recommendations from the third party review, in response to the questions above, will be completed over three years. Implementation effort will be linked with other major work streams of Toronto Central LHIN, such as but not limited to, Local Collaboratives and the integration of Home and Community Care. Key to the success of the implementation plan is imbedding the fundamental principles that: is a spectrum of activities, each of which are equally important, and is a tool to help achieve improved services to patients and clients. 22

& Community Degree of *Based on Kodher s Model Linkage (ad hoc) Coordination Structured Collaboration Program/Service Transfer Full Limited or informal connections One time/ ad hoc working arrangements Ongoing formal partnership/ coordination agreements within a system Program/ service level No structural changes Ongoing formal partnership/ coordination agreements within a system Program/ service level No structural changes Formal transfer, merge or amalgamation of program services May include back office services/functions as well as clinical Creation of single system of care 23

& Community 6. Local Collaboratives Between October 11th and 25th, 2016, over 280 health service providers from across the Toronto Central LHIN along with members of the Citizens Panel and other partnerr, met to begin the process of local collaborative planning. The objectives of the sessions were to develop a common understanding of the Toronto Central LHIN sub-region planning process in the context of other planning activities and leverage community profiles and engagement processes to define preliminary strategic directions as a group. To develop a comprehensive vision for the Local Collaboratives that truly meets the needs of the sub-region and its residents, a strategic visioning activity was conducted with meeting participants where preliminary concepts and themes aimed at creating the Local Collaboratives Vision, Mission, Values and Success Factors were developed. In order to gain a deeper understanding of the local neighborhoods and populations within the sub-region areas, each region analyzed data that captured the unique needs of their particular geography as well as the neighborhoods and groups of people that live within these communities. Participants ensued in discussions on how best to engage patients and community members to validate our community profiles and to provide perspectives that cannot be captured through data alone were held. TC Link Issues 3 and 4 of TC Link, our bi-monthly external facing newsletter for our providers, partnership and members of the public was released in Q3 which amassed over 1336 readers. These issues highlighted work in the areas of Local Collaboratives, Integrated Community Care and Primary Care. The newsletter connects our clients and providers with Local Health Matters, highlighting work, events and resident stories that support the LHIN's strategic plan. Since its inception TC Link has been positively received from providers and has gained steady growth in numbers of reader s month on month and will continue to be a key communication vehicle throughout 2017/18 and beyond. 24

& Community Patients First Act With the passing of Patients First Act (Bill 41) in December, a communications plan was executed with the objective to engage and inform colleagues and provide a clear and positive vision of the new organization for the future. In delivering the plan, a range of communications vehicles were leveraged to deliver key messages through face to face, print and digital channels. This also extended to communication externally with clients and partners who were also engaged and provided with a range of tools to support. The digital channels developed: Transition SharePoint Site - Area created on SharePoint site as a repository of information as a shared resource including Q&A s, information packs etc. for colleagues with tools and information available at all times for reference. Transition TC LHIN Website pages New pages created on the Toronto Central LHIN website providing an overview of the bill, the process in which it came to pass and supplementary information. http://torontocentrallhin.on.ca/resources/patientsfirst.aspx Ask a question mailbox Opportunity for staff to submit their questions and concerns directly to Susan Fitzpatrick (CEO) with the option to do this anonymously. 25